Defining outcomes and opportunities for reproductive health and pregnancy among adolescents in post-conflict Northern Uganda

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The current generation of adolescents 10-24 years old is the largest in human history. Adolescence is a crucial time in terms of health, education and skills which will determine social and economic development over the life course. While focused global action on maternal and child health based on the Millennium Development Goals has resulted in impressive reduction in child mortality, the same cannot be said for adolescent well-being. Sexual, reproductive and maternal health issues remain a leading cause of death in adolescent girls, especially in low income countries. Adolescent pregnancies are associated with exceptionally poor outcomes for both the adolescent mother and child.

Adolescents often lack the awareness, choice and access to health services which contribute to poor sexual health and maternal outcomes. Contraception, family planning, human papillomavirus (HPV) vaccination and screening for sexually transmitted infections (STI) including HIV, gonorrhea, and Chlamydia are feasible, effective prevention tools that, when offered with treatment and counseling can save countless deaths among young people. The way forward is integration of health services where prevention and early treatment packages are tailored to the needs of adolescents.

The civil war in Northern Uganda, which lasted over two decades, displaced over 90% of the region into internally displaced people camps. The majority of this population (70%) was under 25 years old. During the war thousands of children were abducted to become soldiers, forced labourers, and sex slaves. Building on previous research, a team led by Dr. Patricia Spittal launched the Cango Lyec Project in 2011. This cohort consists of a random sample of participants aged 13-59 years in Northern Uganda residing in permanent settlement communities, transition camps, or internal displacement camps.

Through the BC Children’s Hospital Research Institute, Healthy Starts Catalyst program, a team of local researchers were funded to explore key factors related to adolescent health services in Northern Uganda, leveraging the Cango Lyec cohort. Dr Spittal has been leading projects in Northern Uganda since 1998, and is the Principal Investigator of the Cango Lyec Project. Dr Gina Ogilvie is a Canada Research Chair in global control of HPV related cancer & disease, and has been leading a women’s health initiative based in Uganda since 2007. Dr Ashley Roberts is a pediatric infectious diseases physician at BC Children’s Hospital with clinical and research experience in North America and abroad.

This study aims to understand existing access to reproductive and maternal health services for adolescents. Participants completed a survey on pregnancy intentions and outcomes during adolescence and access to sexual health services using community outreach workers who traveled to urban and rural villages in the region in early 2017. Results from the study are forthcoming, where the team will describe services available in this setting, and identify opportunities to improve adolescent maternal health. This data will be used to design future implementation trials and evaluations for adolescents in LMIC.